The prevalence of obesity among African American women in the United States is higher than it is in most other subgroups. In 2005-2006, 52.9% of African American women aged 20 years and older were obese compared with 32.9% of white women. In addition to the obesity disparity, although many African American women attempt weight loss in the US, they are not as successful at weight loss as Caucasian women. There is a need for culturally-tailored interventions to address this important health disparity in obesity and weight loss success. The postpartum period may offer an optimal opportunity to reach overweight and obese African American women for behavioral intervention;this time is a period women are especially tied to clinical care and highly motivated to lose weight. Our current proposal, entitled Reducing Obesity in Underserved Postpartum African American Women, develops and pilot-tests a culturally-tailored, clinic-based weight management program (diet and exercise-focused) to reduce obesity among postpartum African American women. Specifically, the program adapts a multi-session effective weight loss program demonstrating success with patients contending with impaired glucose tolerance, the Diabetes Prevention Program (DPP), combined with culturally-tailored patient navigation strategies to support clinical care utilization and health promotion behaviors in our target population of obese postpartum African American women. Peer counselors (Birth Sisters) will serve as patient navigators supporting program participation and health care access. The specific aims of this project are to: 1a) pilot-test a culturally-tailored, clinic-based weight loss program with the goal of assessing the feasibility, receptivity, and potential utility of the program for obese postpartum African American women;1b) conduct a process evaluation to ensure high quality of program implementation and to obtain feedback from program participants and staff on their experiences with the program. Session observations, surveys, and interviews with program participants and staff will be conducted to provide data on the feasibility and receptivity of the program;and 2) conduct a preliminary evaluation of the intervention's effectiveness on weight loss, looking at 30 weeks postpartum change in weight and 12 month maintenance of weight loss, as compared to 6 week postpartum weight. Secondary outcomes will also be evaluated, including 30 week changes in behaviors as measured by change in physical activity, total daily caloric intake, and percent of total daily fat calories, and 12 month maintenance of these behaviors. A 2-armed randomized controlled trial will be undertaken for this evaluation, comparing the intervention participants (n=80) to control participants (n=80). This proposed study is both innovative and significant in its approach to reduce the racial disparity in obesity for African American women because it a) targets weight loss during postpartum, a time of significant weight loss need for obesity-vulnerable women and b) builds upon an existing culturally-tailored, empirically-supported clinical model, patient navigation (i.e. Birth Sisters), to support intervention involvement. PUBLIC HEALTH RELEVANCE: African American women are 60% more likely to be obese relative to white women in the US;in 2005-2006, 52.9% of non-Hispanic black women over 20 years of age were obese compared with 32.9% of non-Hispanic white women. Obesity risk for this African American population escalates in the postpartum period. This project seeks to reduce this disparity via a culturally-tailored intervention targeting postpartum weight retention in African American women, using an adaptation of the Diabetes Prevention Program as the intensive lifestyle component in addition to patient navigators to enhance compliance and provide social support and, if successful, this pilot study could become a model for an effort to reduce the disparity in the high prevalence of obesity and other co morbidities in African American women in the US.